Provider Demographics
NPI:1619167459
Name:UROLOGY FOR CHILDREN
Entity Type:Organization
Organization Name:UROLOGY FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-751-7880
Mailing Address - Street 1:2701 BLAIR MILL RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1041
Mailing Address - Country:US
Mailing Address - Phone:856-751-7880
Mailing Address - Fax:856-751-9133
Practice Address - Street 1:2701 BLAIR MILL RD
Practice Address - Street 2:STE 6
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1041
Practice Address - Country:US
Practice Address - Phone:215-707-6469
Practice Address - Fax:856-751-9133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UROLOGY FOR CHILDREN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1871584101Medicaid
NJ8699607Medicaid